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Non-cannulated versus cannulated cancellous screws for the internal fixation of femoral neck fractures in osteoporotic patients: A single-blind randomized clinical trial. | LitMetric

AI Article Synopsis

  • The study aimed to compare the outcomes of two types of screws (non-cannulated cancellous screws - NCS, and cannulated cancellous screws - CS) in treating undisplaced intracapsular femoral neck fractures in osteoporotic patients.
  • Conducted in Iran, the trial involved 57 patients and evaluated factors like surgical duration, blood loss, complications, and hip function over two years.
  • Results indicated that while CS had better perioperative outcomes and lower implant failures, NCS patients achieved higher hip function scores, suggesting a trade-off between immediate surgery effectiveness and long-term recovery.

Article Abstract

Background: The incidence of femoral neck fractures in osteoporotic patients is rising worldwide and is associated with significant increases in healthcare and social costs, as well as dependency. Improving minimally invasive treatment strategies, including internal fixation with screws, can result in favorable clinical outcomes and lesser incidence of complications, while preserving the hip. This study compared the outcomes of using non-cannulated cancellous screws (NCS) and cannulated cancellous screws (CS) in the internal fixation of undisplaced intracapsular femoral neck fractures (UIFNF) of osteoporotic patients of Iranian descent.

Methods: This randomized clinical trial was conducted on the patients referring to an institutional tertiary hospital in northwestern Iran between March 2020 and June 2021. The patients' preoperative, perioperative, and postoperative characteristics were evaluated for at least two years. Primary endpoints were defined as the incidence of hip-related complications, while secondary endpoints were assessed based on the patients' hip function using Harris Hip Score (HHS).

Results: Fifty-seven patients with osteoporosis and UIFNF were included in the final analysis, with 27 patients in the NCS group and 30 patients in the CS group. The surgical duration, the amount of intraoperative blood loss, and the frequency of C-arm were considerably lower in the CS group (p < 0.05). The incidence of implant failure was higher in the NCS group (p = 0.04). Screw migration occurred more frequently in the CS group (p = 0.03). The HHS values were significantly higher for the NCS group than those of the CS group at both the 1-year and 2-years of follow-up assessments (1 year, p = 0.007; 2 years, p = 0.001).

Conclusion: Fixation using CS was accompanied by enhanced perioperative outcomes and lower implant failure rates compared to the NCS group. However, patients in the NCS group posed a reduced risk of complications, including screw migration, and experienced a long-term improvement in HHS scores.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10825919PMC
http://dx.doi.org/10.1016/j.jor.2023.11.074DOI Listing

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